S1418
Interdisciplinary - Health economics & health services research
ESTRO 2026
Department of Radiation Oncology, Maria Sklodowska- Curie National Research Institute of Oncology, Warsaw, Poland Purpose/Objective: Proton therapy provides significant benefits over conventional photon therapy for selected patients. However, due to the high costs of construction and operation, proton therapy centers remain scarce and unevenly distributed across Europe [1]. Limited travel accessibility remains a major barrier to receiving proton therapy [2]. This study aimed to quantify current geographic access to proton therapy across Europe and to evaluate how potential improvements, such as formalized cross-border access or the strategic establishment of new centers, could reduce these disparities. Material/Methods: We analyzed the situation in 32 countries, all within the European Economic Area, the United Kingdom, and Switzerland. Data on existing and planned proton therapy centers were obtained from the Particle Therapy Co-Operative Group (PTCOG) database. For each of 69,929 subregions defined by the Database of Global Administrative Areas (GADM), we calculated car travel times between the subregion’s centroid and the nearest proton therapy center using OpenStreetMap routing algorithms. We then evaluated three improvement scenarios: (1) open cross-border access to all currently operating centers; (2) the projected situation in 2030, including centers under construction or planned; and (3) an optimized scenario for 2030 using a custom greedy Maximal Coverage Location Problem (MCLP) model to identify locations for five new centers that would maximize population coverage in the most underserved regions. Results: Currently, there are 29 operational proton therapy centers in Europe that provide access within 240 minutes to 59% of the population in the studied countries (Figure A). Allowing cross-border access would immediately increase this coverage to 65%, reaching an additional 32 million people (Figure B).
By 2030, 21 new centers are planned, which would further raise 240-minute access to 80%, assuming open cross-border access (Figure C). However, substantial underserved areas would still remain. Our MCLP model indicated that establishing only five strategically located new centers, in Romania, Greece, Italy, Northern Ireland, and Poland, would increase 240-minute accessibility to 87% of the European population (Figure D).
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